Basic Information
| Provider Information | |||||||||
| NPI: | 1720139314 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANZIK | ||||||||
| FirstName: | JOLENE | ||||||||
| MiddleName: | SONNIER | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SONNIER | ||||||||
| OtherFirstName: | JOLENE | ||||||||
| OtherMiddleName: | DENICE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 13820 MONTCLAIR HILL COURT | ||||||||
| Address2: | |||||||||
| City: | ROSHARON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814316771 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1635 NORTH LOOP WEST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138672000 | ||||||||
| FaxNumber: | 7138672099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 650874 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1791931 | 05 | TX | MEDICAID |